Healthcare Provider Details

I. General information

NPI: 1982291779
Provider Name (Legal Business Name): MONICA MICHELLE PEARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 NW 113TH ST
OKLAHOMA CITY OK
73162-2903
US

IV. Provider business mailing address

6516 NW 113TH ST
OKLAHOMA CITY OK
73162-2903
US

V. Phone/Fax

Practice location:
  • Phone: 405-204-0275
  • Fax:
Mailing address:
  • Phone: 405-204-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number951160
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number00000
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: